Provider Demographics
NPI:1902398001
Name:NEUROGROVE, PC
Entity type:Organization
Organization Name:NEUROGROVE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:ND, MPH, BCB, NMIT
Authorized Official - Phone:720-280-7017
Mailing Address - Street 1:5511 W 56TH AVE UNIT 100
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2807
Mailing Address - Country:US
Mailing Address - Phone:303-828-7473
Mailing Address - Fax:
Practice Address - Street 1:5511 W 56TH AVE UNIT 100
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2807
Practice Address - Country:US
Practice Address - Phone:303-828-7473
Practice Address - Fax:303-997-6971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO09925305202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty